2. Turn – Health care workers cause poverty – immediate influx of cash causes rapid inflation, increases class divisions, and stifles innovation
Laurie Garrett, Senior Fellow for Global Health at the Council on Foreign Relations, 2-07, Foreign Affairs, “The Challenge of Global Health”
Some analysts, meanwhile, insist that massive infusions of foreign cash into the public sector undermine local manufacturing and economic development. Thus, Arvind Subramanian, of the IMF, points out that all the best talent in Mozambique and Uganda is tied up in what he calls "the aid industry," and, he says, foreign-aid efforts suck all the air out of local innovation and entrepreneurship. {See Footnote 1} A more immediate concern is that raising salaries for health-care workers and managers directly involved in HIV/AIDS and other health programs will lead to salary boosts in other public sectors and spawn inflation in the countries in question. This would widen the gap between the rich and the poor, pushing the costs of staples beyond the reach of many citizens. If not carefully managed, the influx of cash could exacerbate such conditions as malnutrition and homelessness while undermining any possibility that local industries could eventually grow and support themselves through competitive exports.
Regardless of whether these problems proliferate, it is curious that even the most ardent capitalist nations funnel few if any resources toward local industries and profit centers related to health. Ministries of health in poor countries face increasing competition from NGOs and relief agencies but almost none from their local private sectors. This should be troubling, because if no locals can profit legitimately from any aspect of health care, it is unlikely that poor countries will ever be able to escape dependency on foreign aid.
1. Over use of medicine is dangerous – it will eventually cause resistance which increases drug prices and gets rid of the low hanging fruits of R&D
The patent bargain assumes that information entering the public domain remains there. n44 This static assumption is not always appropriate when considering dynamic living systems. Some pharmaceutical knowledge is exhaustible (rivalrous) due to evolutionary response. n45 When pharmaceutical knowledge is exhaustible, it loses its nonrivalrous character. This Article identifies this condition as "Exhaustible Pharmaceutical Knowledge" or EPK. n46
While generalizations are dangerous in this area of microbiology, resistance generally proceeds more quickly the more a drug is utilized. n47 [*77] Patient compliance is also an important factor, n48 as is the location and intensity of use. n49 Many factors affect the exhaustion rate of EPK and whether resistance can be reversed. Conserving EPK to stave off resistance is a complicated affair but an important approach if the pace of new drug introductions has slowed. n50
Thus far, discussions of EPK have focused upon discrete packets of knowledge, usually embodied in the patents listed in the FDA Orange Book n51 for a particular drug. However, pharmaceutical knowledge may potentially be exhaustible in a global sense. Some biologists believe that we have already harvested the low- hanging fruit of easily discoverable antibiotics. n52 Some suspect that perhaps the tree itself is bare. n53 If the number of possible antibiotic targets is finite, then resistance will eventually master them all. This problem is not fundamentally changed if one discounts the word finite but acknowledges that diminishing returns and increasing costs can make the discovery of additional EPK economically impractical. n54 In a global sense, EPK may be a finite resource like fossil fuels.
The implications are profound. We might be content to allow the market to price fossil fuels, but for EPK, price-rationing is unacceptable. n55 If EPK is [*78] finite like fossil fuels, investments in traditional drug discovery R&D only hasten the day of exhaustion, and conservation must be given first priority. Under these conditions, only conservation expands the total treatment capacity over time. R&D priorities may need to be directed away from traditional drug discovery and greater emphasis placed on conservation.
2. Increasing antibiotic use and treatment in Africa spreads resistant strains of disease that would otherwise preventable, it even creates a legal form of TB
Laurie Garrett, Senior Fellow for Global Health at the Council on Foreign Relations, 2-07, Foreign Affairs, “The Challenge of Global Health”
But HIV does not spread in a vacuum. In the very South African communities in which it flourishes, another deadly scourge has emerged: XDR-TB, a strain of TB so horribly mutated as to be resistant to all available antibiotics. Spreading most rapidly among people whose bodies are weakened by HIV, this form of TB, which is currently almost always lethal, endangers communities all over the world. In August 2006, researchers first announced the discovery of XDR-TB in KwaZulu-Natal, and since then outbreaks have been identified in nine other South African provinces and across the southern part of the continent more generally. The emergence of XDR-TB in KwaZulu-Natal was no doubt linked to the sorry state of the region's general health system, where TB treatment was so poorly handled that only a third of those treated for regular TB completed the antibiotic therapy. Failed therapy often promotes the emergence of drug-resistant strains.
There is also an intimate relationship between HIV and malaria, particularly for pregnant women: being infected with one exacerbates cases of the other. Physicians administering ARVs in West Africa have noticed a resurgence of clinical leprosy and hepatitis C, as latent infections paradoxically surge in patients whose HIV is controlled by medicine. HIV-positive children face a greater risk of dying from vaccine-preventable diseases, such as measles, polio, and typhoid fever, if they have not been immunized than do those nonimmunized children without HIV. But if financial constraints force health-care workers to reuse syringes for a mass vaccination campaign in a community with a Vulindlela-like HIV prevalence, they will almost certainly spread HIV among the patients they vaccinate. And if the surgical instruments in clinics and hospitals are inadequately sterilized or the blood-bank system lacks proper testing, HIV can easily spread to the general population (as has happened in Canada, France, Japan, Kazakhstan, Libya, Romania, and elsewhere).
Laurie Garrett, Senior Fellow for Global Health at the Council on Foreign Relations, 2-07, Foreign Affairs, “The Challenge of Global Health”
Some analysts, meanwhile, insist that massive infusions of foreign cash into the public sector undermine local manufacturing and economic development. Thus, Arvind Subramanian, of the IMF, points out that all the best talent in Mozambique and Uganda is tied up in what he calls "the aid industry," and, he says, foreign-aid efforts suck all the air out of local innovation and entrepreneurship. {See Footnote 1} A more immediate concern is that raising salaries for health-care workers and managers directly involved in HIV/AIDS and other health programs will lead to salary boosts in other public sectors and spawn inflation in the countries in question. This would widen the gap between the rich and the poor, pushing the costs of staples beyond the reach of many citizens. If not carefully managed, the influx of cash could exacerbate such conditions as malnutrition and homelessness while undermining any possibility that local industries could eventually grow and support themselves through competitive exports.
Regardless of whether these problems proliferate, it is curious that even the most ardent capitalist nations funnel few if any resources toward local industries and profit centers related to health. Ministries of health in poor countries face increasing competition from NGOs and relief agencies but almost none from their local private sectors. This should be troubling, because if no locals can profit legitimately from any aspect of health care, it is unlikely that poor countries will ever be able to escape dependency on foreign aid.
1. Over use of medicine is dangerous – it will eventually cause resistance which increases drug prices and gets rid of the low hanging fruits of R&D
The patent bargain assumes that information entering the public domain remains there. n44 This static assumption is not always appropriate when considering dynamic living systems. Some pharmaceutical knowledge is exhaustible (rivalrous) due to evolutionary response. n45 When pharmaceutical knowledge is exhaustible, it loses its nonrivalrous character. This Article identifies this condition as "Exhaustible Pharmaceutical Knowledge" or EPK. n46
While generalizations are dangerous in this area of microbiology, resistance generally proceeds more quickly the more a drug is utilized. n47 [*77] Patient compliance is also an important factor, n48 as is the location and intensity of use. n49 Many factors affect the exhaustion rate of EPK and whether resistance can be reversed. Conserving EPK to stave off resistance is a complicated affair but an important approach if the pace of new drug introductions has slowed. n50
Thus far, discussions of EPK have focused upon discrete packets of knowledge, usually embodied in the patents listed in the FDA Orange Book n51 for a particular drug. However, pharmaceutical knowledge may potentially be exhaustible in a global sense. Some biologists believe that we have already harvested the low- hanging fruit of easily discoverable antibiotics. n52 Some suspect that perhaps the tree itself is bare. n53 If the number of possible antibiotic targets is finite, then resistance will eventually master them all. This problem is not fundamentally changed if one discounts the word finite but acknowledges that diminishing returns and increasing costs can make the discovery of additional EPK economically impractical. n54 In a global sense, EPK may be a finite resource like fossil fuels.
The implications are profound. We might be content to allow the market to price fossil fuels, but for EPK, price-rationing is unacceptable. n55 If EPK is [*78] finite like fossil fuels, investments in traditional drug discovery R&D only hasten the day of exhaustion, and conservation must be given first priority. Under these conditions, only conservation expands the total treatment capacity over time. R&D priorities may need to be directed away from traditional drug discovery and greater emphasis placed on conservation.
2. Increasing antibiotic use and treatment in Africa spreads resistant strains of disease that would otherwise preventable, it even creates a legal form of TB
Laurie Garrett, Senior Fellow for Global Health at the Council on Foreign Relations, 2-07, Foreign Affairs, “The Challenge of Global Health”
But HIV does not spread in a vacuum. In the very South African communities in which it flourishes, another deadly scourge has emerged: XDR-TB, a strain of TB so horribly mutated as to be resistant to all available antibiotics. Spreading most rapidly among people whose bodies are weakened by HIV, this form of TB, which is currently almost always lethal, endangers communities all over the world. In August 2006, researchers first announced the discovery of XDR-TB in KwaZulu-Natal, and since then outbreaks have been identified in nine other South African provinces and across the southern part of the continent more generally. The emergence of XDR-TB in KwaZulu-Natal was no doubt linked to the sorry state of the region's general health system, where TB treatment was so poorly handled that only a third of those treated for regular TB completed the antibiotic therapy. Failed therapy often promotes the emergence of drug-resistant strains.
There is also an intimate relationship between HIV and malaria, particularly for pregnant women: being infected with one exacerbates cases of the other. Physicians administering ARVs in West Africa have noticed a resurgence of clinical leprosy and hepatitis C, as latent infections paradoxically surge in patients whose HIV is controlled by medicine. HIV-positive children face a greater risk of dying from vaccine-preventable diseases, such as measles, polio, and typhoid fever, if they have not been immunized than do those nonimmunized children without HIV. But if financial constraints force health-care workers to reuse syringes for a mass vaccination campaign in a community with a Vulindlela-like HIV prevalence, they will almost certainly spread HIV among the patients they vaccinate. And if the surgical instruments in clinics and hospitals are inadequately sterilized or the blood-bank system lacks proper testing, HIV can easily spread to the general population (as has happened in Canada, France, Japan, Kazakhstan, Libya, Romania, and elsewhere).